Signet ring cell carcinoma
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Signet ring cell carcinoma, abbreviated SRCC, is a type of malignant epithelial neoplasm that can arise from a number of places. It is commonly associated with the stomach.
| Signet ring cell carcinoma | |
|---|---|
| Diagnosis in short | |
 Signet ring cell carcinoma. H&E stain | |
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| |
| LM | ovoid cells with abundant cytoplasm and a peripheral crescentic hyperchromatic nucleus |
| LM DDx | serous fat atrophy, benign histiocytes (mucocele, xanthoma) |
| Stains | mucicarmine stain, PAS stain |
| IHC | pankeratin +ve, CD68 -ve |
| Site | stomach, small intestine, large intestine, breast, pancreas, urinary bladder, prostate gland, lung |
|
| |
| Associated Dx | Invasive lobular carcinoma, mucinous carcinoma |
| Syndromes | familial diffuse gastric cancer |
|
| |
| Prevalence | uncommon |
| Endoscopy | linitis plastica (classic finding in the stomach) |
| Prognosis | poor |
| Signet ring cell carcinoma | |
|---|---|
| External resources | |
| EHVSC | 9982 |
| Wikipedia | Signet ring cell carcinoma |
General
- Signet ring cell carcinoma are notoriously easy to miss in a small biopsy.
- It has been said that there are two types of pathologists... those that have missed SRCCs and those that will miss SRCCs.
- The name comes from the shape of cells. They look like signet rings that are lying flat on the ground and one is looking from above - see microscopic section.
Differential diagnosis
It may arise from the:[1]
Microscopic
Features:
- Signet ring cells resemble signet rings.
- They contain a large amount of mucin, which pushes the nucleus to the cell periphery.
- The pool of mucin in a signet ring cell mimics the appearance of the finger hole.
- The nucleus mimics the appearance of the face of the ring in profile.
- Signet ring cells are typically 2-3x the size of a lymphocyte.
- Smaller than the typical adipocyte.
- Often have a crescent-shaped or ovoid nucleus.
- Capillaries sectioned on their lumen have endothelial cells - the nuclei of these are more spindled.
Note:
- SRCs are usually close to friend, i.e. they are adjacent to another SRC.
- This helps differentiate SRCs from capillaries sectioned on their lumen.
- The mucin is often clear on H&E... but maybe eosinophilic.
DDx:
- Serous fat atrophy.[2]
- Mucocele - muciphages may mimic signet ring cells.[3]
- Muciphages = cytoplasm lightly eosinophilic, multivaculated (classic) or finely reticulated.
- Gastric xanthoma.
- Crypt cell carcinoma (goblet cell carcinoid).[4]
- Ischemic mucosal changes - cells within the lumen.[5]
Images
A medieval signet ring. On the left it is lying flat and looks similar to a so called signet ring cell. (WC/Staves)
.jpg)
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Case - stomach
SRCC - low mag. - demonstrating that it can be subtle. (WC/Nephron)
SRCC - high mag. (WC/Nephron)
SRCC - very high mag. (WC/Nephron)
Case - bladder
SRCC - bladder - intermed. mag.
SRCC - bladder - intermed. mag.
SRCC - bladder - high mag.
SRCC - bladder - very high mag.
Additional cases
SRCC metastasis. (WC/Nephron)
SRCC. (WC/KGH)
SRCC - PAS stain. (WC/KGH)
.jpg)
_PAS_stain.jpg)
Stains
- PAS stain +ve.
- Alcian blue-PAS stain +ve.[6]
IHC
- AE1/AE3 +ve.
- CK7 +ve.
See also
References
- ↑ URL: http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/what-is-a-signet-cell-cancer. Accessed on: 7 March 2012.
- ↑ Clarke, BE.; Brown, DJ.; Xipell, JM. (Jan 1983). "Gelatinous transformation of the bone marrow.". Pathology 15 (1): 85-8. PMID 6222282.
- ↑ De Petris, G.; Lev, R.; Siew, S. (May 1998). "Peritumoral and nodal muciphages.". Am J Surg Pathol 22 (5): 545-9. PMID 9591723.
- ↑ Pericleous, M.; Lumgair, H.; Baneke, A.; Morgan-Rowe, L.; E Caplin, M.; Luong, TV.; Thirlwell, C.; Gillmore, R. et al. (May 2012). "Appendiceal goblet cell carcinoid tumour: a case of unexpected lung metastasis.". Case Rep Oncol 5 (2): 332-8. doi:000339607. PMID 22933998.
- ↑ Dhingra, S.; Wang, H. (Dec 2011). "Nonneoplastic signet-ring cell change in gastrointestinal and biliary tracts: a pitfall for overdiagnosis.". Ann Diagn Pathol 15 (6): 490-6. doi:10.1016/j.anndiagpath.2011.07.006. PMID 22082777.
- ↑ Terada, T. (2013). "An immunohistochemical study of primary signet-ring cell carcinoma of the stomach and colorectum: I. Cytokeratin profile in 42 cases.". Int J Clin Exp Pathol 6 (4): 703-10. PMID 23573317.